<?php
get_header();
?>
<div class="content-sidebar span9">
    <div class="page-about-us">
        <div class="inner-page-title"><h1>Contact Us</h1></div>
        <div class="submit-content">
            <p class="note-contact">
                If you need to get in touch with us, please fill out the form below and we'll get back to you as soon as possible.
            </p>
            <form name="contact-us">
                <div class="form-wrapper">
                    <span class="field-title">Name:</span><br/>
                    <input name="txt_name" placeholder="Your name"/>
                </div>
                <div class="form-wrapper">
                    <span class="field-title">Email:</span><br/>
                    <input name="txt_email" placeholder="Your Email address"/>
                    <span class="email_err">* Email is not correct</span>
                </div>
                <div class="form-wrapper">
                    <span class="field-title">Subject:</span><br/>
                    <input name="txt_subject" placeholder="Subject"/>
                </div>
                <div class="radio-button">
                    <label class="field-title">
                        <input type="radio" name="rdo_for" class="radio-type" checked="checked" value="support"/> Support
                    </label>
                    <label class="field-title">
                        <input type="radio" name="rdo_for" class="radio-type" value="partner"/> Partnerships
                    </label>
                </div>
                <div class="form-wrapper">
                    <span class="field-title">Message:</span><br/>
                    <textarea name="txa_message" placeholder=""></textarea>
                </div>
                <div class="row-fluid wrap-captcha security">
                    <img class="captcha_code" src="<?php echo get_template_directory_uri() . '/inc/captcha/captcha_code_file.php'; ?>" alt="captcha"/>
                    <input id="security_code" class="word" placeholder="Security Code" autocomplete="off" name="6_letters_code" type="text" />
                    <p class="captcha_missing">*Captcha not correct</p>
                </div>
                <div class="row-fluid">
                    <input type="submit" name="btn_contact" value="Submit"/>
                </div>
            </form>
        </div>
    </div>
</div>
<div class="right-sidebar span3">
    <?php if (is_active_sidebar('cs-span4-right-sidebar')) dynamic_sidebar('cs-span4-right-sidebar'); ?>
</div>

<?php get_footer(); ?>